Note: A portion of this story was aired as part of the Health & Wealth Update for 5/14/2014

When I think about adult dental care in Missouri, I think of Ben Affleck. In the movie Argo, CIA agent Tony Mendez, played by Affleck, pitches his plan to extract six American hostages from Iran by pretending to be on a Hollywood scouting trip. The CIA director doesn’t think it’ll work and wants to look for a better option. That’s when Mendez says:

“There are only bad options. It’s about finding the best one.”

That’s what it’s like for Missourians who can’t afford private dental insurance. Back in 2005 Missouri de-funded dental care for all Medicaid recipients except, children, pregnant women and the disabled. And it’s left a lot of people with only bad options.

Many find themselves in the ER with tooth infections, where cost for treatment per patient can run on average around $9,000. Some try to find affordable care at Federally Qualified Health Centers where services are discounted for low-income patients, but aren’t free.

But for Missouri’s very poor, the only option is charity dental care. And there are very few people who do this kind of work. Dr. William Kane is a dentist who runs a charity dental clinic called Smiles of Hope in Dexter, Mo. The clinic started as a partnership with Southeast Missouri State University, but for the past two years Kane’s been running it on his own, on a shoestring budget. He receives hundreds of applications for appointments each month from all over the boot heel region of Missouri and from as far away as Kentucky and West Virginia. Every month Dr. Kane and two other dentists treat 60-70 patients over the course of one day. He calls it controlled chaos. There are so many people in need of emergency dental care, that he compares the clinic to a M.A.S.H unit – a mass casualty dental clinic.

Smiles of Hope is run out of the Lighthouse Christian Center church in Dexter. Volunteers converted an old attic space into what is now the exam room. At first glance you could be fooled into thinking you’ve walked into a professional dental office. Only after looking closely do you realize everything is mismatched – from the color of the chairs, to the supply cabinets, to those overhead lights dentists use. Some of it’s been at a discount, but mostly the clinic runs on donations. Kane does, however, have to pay for his equipment when it breaks. A while back he had to get his sterilizer repaired to the tune of $1,700. A software issue with the x-ray machine cost $1,500. That money comes from the $20 fee the patients pay to get treated here. The clinic could certainly use more money, but Kane says $20 is really all these people can afford.

"We see patients, working poor, people who are on Medicaid, that the only time they get dentistry is when they go to the ER for antibiotics and pain medicine," says Kane. "So we're seeing desperate people."

The day officially starts at 6:00 am with a quick medical exam – blood pressure, heart rate, medical history. Then people are moved upstairs in small groups for triage. The dentist takes a look at your mouth, asks you what hurts, determines what tooth needs to be pulled that day. A lot of the patients come with more issues than the clinic can handle in one sitting.

"Unfortunately we are an emergency room," says Kane. "We will get some patients in that need cleanings or restore a simple filling. We have to refer them elsewhere," he says.

This year the Missouri legislature agreed to re-fund adult dental care under Medicaid for the first time in a decade, which will likely reduce the number of people in need of free dental services. But as we in Missouri know, 300,000 low income adults who could qualify for Medicaid under the ACA don’t, because the state has so far decided not to expand the program. Which means Smiles of Hope isn’t going anywhere.

When I arrive at the church around 5:30 the next morning I don’t see any signs of life. But I do smell something - it's bacon. Patients get a free breakfast at Smiles of Hope Clinic prepared for them by volunteer church members, because once a patient gets their tooth pulled, it’ll be hard for them to eat for a while.

Inside the church there’s activity, but nothing like the M.A.S.H unit Dr. Kane had described. A few patients are sitting in chairs along the wall in the church entranceway, waiting to be called into the x-ray room across the hall.

Crystal McKuin is a 27-yr-old single mother from Sikeston, Mo. It's her first time at the clinic and she says she's had tooth pain for almost a whole year.

Like a lot of other patients, McKuin heard about Smiles of Hope from a friend. News of the clinic spreads quickly among those most desperate for its services.

"A lot of other dentists just ain’t affordable to me and being a single mom it’s hard to pay for dentists," says McKuin. "I was just told by a friend that they do cheap dentists and I’ve been in a lot of pain recently so I’m hoping to get my teeth removed."

By 6:30 am everyone has arrived and upstairs triage is underway. The dentists are getting a first look at patients teeth, and their medical histories are checked to make sure they can be numbed safely and, if necessary, given antibiotics to fight infection.

The volunteers I meet are surprisingly energized for such an early hour, and without exception, extremely kind people. They walk patients through every stage of the clinic, commiserate with them - even try to get them to crack a smile.

Breakfast is served promptly at 8:00, and then the real work begins. McKuin tells me that this isn't the first time she has been to a dentist for this problem. A few months ago she had gone to a Federally Qualified Health Center in Bernie. Mo. They took an x-ray of her teeth and told her which ones needed to be pulled – that’s it. She paid them $50 and the next day signed up for Smiles of Hope.

"We do see that sometimes they're referred here for whatever reason they can’t afford the fees at the Federally Qualified Health Center even on a sliding scale so they tell them to come here," says Kane. "They're the safety net for private practice and, in reality, we're the safety net for the safety net."

That’s what I learned from visiting this clinic. Even the feds send its most desperate people here. You might have thought that having to rely on government assistance represented the last stop for these people – but in reality the last stop is a clinic run by volunteer church members serving breakfast to complete strangers.